Dental and Oral Health
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Questions and Answers

What percentage of Australian children aged 6-14 had dental caries in their permanent teeth?

  • 24% (correct)
  • 10%
  • 40%
  • 30%

    • What is the main cause of dental caries?

  • Lack of dental care
  • Genetic predisposition
  • Poor oral hygiene
  • Bacteria in the plaque producing acid (correct)

    • What can happen if dental caries is left untreated?

  • The tooth may lead to fatal consequences (correct)
  • The tooth will repair itself
  • The tooth will become more sensitive
  • The tooth will turn yellow

    • What is the name of the condition where bacteria in the plaque produce acid that demineralizes the tooth structure?

    <p>Dental caries</p> Signup and view all the answers

    Why do people often visit pharmacies instead of dentists?

    <p>Pharmacies are free and more friendly</p> Signup and view all the answers

    What is the name of the condition where the jawbone dies due to medication?

    <p>MRONJ</p> Signup and view all the answers

    When can dental caries occur?

    <p>As soon as teeth erupt</p> Signup and view all the answers

    What is the consequence of untreated tooth loss?

    <p>Poor nutrition and speech difficulties</p> Signup and view all the answers

    What is the primary purpose of 'deep cleaning' in dentistry?

    <p>To remove plaque and calculus from beneath the gums</p> Signup and view all the answers

    What is the precursor to periodontitis?

    <p>Gingivitis</p> Signup and view all the answers

    What is the recommended treatment for gingivitis?

    <p>Improved oral hygiene and professional dental prophylaxis</p> Signup and view all the answers

    What is alveolar osteitis?

    <p>A localized painful inflammation of the bone surrounding an extraction socket</p> Signup and view all the answers

    What is the incidence of MRONJ in patients with metabolic bone disease?

    <p>0.1%</p> Signup and view all the answers

    What is the pathogenesis of alveolar osteitis?

    <p>Smoking and excessive spitting</p> Signup and view all the answers

    What is the recommended treatment for alveolar osteitis?

    <p>Self-limiting, analgesics, and saline/CHX irrigation</p> Signup and view all the answers

    Why is counseling important for patients taking bisphosphonates?

    <p>To prevent MRONJ</p> Signup and view all the answers

    What is the recommended duration for an ulcer to last before advising further action?

    <p>2 weeks</p> Signup and view all the answers

    What is the name of the viral illness that causes painful ulcers in the mouth, often in the back of the throat and roof of the mouth?

    <p>Herpangina</p> Signup and view all the answers

    What is the name of the disease that is accompanied by small oval blisters on the palms and soles of feet?

    <p>Hand, foot and mouth disease</p> Signup and view all the answers

    What is the term for the stage that precedes the appearance of lesions in Herpes Simplex Labialis?

    <p>Prodromal stage</p> Signup and view all the answers

    What is the name of the virus that causes Herpes Simplex Labialis?

    <p>HSV</p> Signup and view all the answers

    What is the role of hygiene in preventing fungal infections?

    <p>It is important</p> Signup and view all the answers

    What is the type of organism that causes oral candidiasis?

    <p>Fungal</p> Signup and view all the answers

    What is the course of action for fungal infections?

    <p>Referral to a dentist or GP</p> Signup and view all the answers

    What could be a sinister outcome if an intra-oral white lesion is not removed?

    <p>Cancer</p> Signup and view all the answers

    Which of the following is NOT a cause of dry mouth?

    <p>Eating too much sugar</p> Signup and view all the answers

    What can chronic dry mouth contribute to?

    <p>All of the above</p> Signup and view all the answers

    What is a recommended treatment for dry mouth?

    <p>Drinking water regularly</p> Signup and view all the answers

    Why should teething gels not be used?

    <p>They are not effective and may be harmful</p> Signup and view all the answers

    What is a common concern for edentulous patients?

    <p>Loose dentures</p> Signup and view all the answers

    What can be offered to patients with denture concerns?

    <p>All of the above</p> Signup and view all the answers

    What is a potential cause of denture concerns?

    <p>Incorrectly made dentures</p> Signup and view all the answers

    What is the primary cause of bone loss around the teeth in Periodontitis?

    <p>Bacterial attachment to the teeth</p> Signup and view all the answers

    What is the recommended treatment for a fractured tooth?

    <p>Supply of analgesics to temporize until the patient sees a dentist</p> Signup and view all the answers

    What is the proportion of adults with moderate or severe Periodontitis in 55-74 year olds?

    <p>51%</p> Signup and view all the answers

    What is the relationship between Periodontitis and type 2 diabetes?

    <p>Bidirectional</p> Signup and view all the answers

    What is the maximum dose of Paracetamol recommended for pain relief?

    <p>4g</p> Signup and view all the answers

    What is the consequence of untreated Periodontitis?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended dosage of Ibuprofen for pain relief?

    <p>2.4g</p> Signup and view all the answers

    What is the common symptom of a fractured tooth?

    <p>Vague, episodic pain on chewing/biting</p> Signup and view all the answers

    Study Notes

    Dental and Oral Health

    • Conditions concerning the hard tissues of the oral cavity (teeth, bones)
    • Conditions concerning the soft tissues of the oral cavity (everything aside from teeth and bones)
    • Issues concerning patients with no teeth (paediatrics and geriatrics)
    • Items found in the oral health section of community pharmacies

    Dental Caries

    • What: Holes in teeth, also known as cavities
    • When: As soon as teeth erupt (can be in primary dentition, i.e., baby teeth, or permanent dentition, i.e., adult teeth)
    • Why: When dental plaque adheres to the surface of teeth and is not removed for a substantial period of time, bacteria (predominantly Streptococcus mutans) adhere to the plaque and produce an acid that demineralizes the tooth structure
    • Prevalence: Around 1 in 4 (24%) Australian children aged 6-14 had dental caries in their permanent teeth, around 1 in 10 (11%) had at least one permanent tooth with untreated decay

    Effect of Dental Caries and Treatment

    • Painful, causing sensitivity, pain, and in some cases, severe pain
    • Untreated may lead to tooth loss (extraction) which has broader consequences (poor mastication, speech, dysphagia, ongoing problems with nutrition)
    • Untreated may infect the pulp chamber leading to a spreading infection with sometimes fatal consequences (e.g., Ludwig's angina, cavernous sinus thrombosis)
    • Treatment: Requires a dentist; tooth may be restored; root canal treatment may be necessary or extraction
    • Supply of analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)

    Fractured Teeth/Cracked Tooth Syndrome

    • Patients present with vague symptoms, poorly localized, episodic, pain on chewing/biting
    • Fractures of teeth are the third most common cause of tooth loss in industrialized countries
    • Generally, patients don't know their teeth are fractured
    • Supply of analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)

    Periodontitis

    • What: Inflammation of the ligaments attaching the tooth to bone leading to bone loss around the teeth
    • When: Takes time to advance to level of bone loss, begins as gingivitis and progresses when left untreated
    • Why: Foreign body stuck to teeth, bacterial attachment, localized inflammation (cytokines, matrix metalloproteinases) leading to bone loss
    • Relation to type 2 diabetes: Have a relation to type 2 diabetes; if the patient gets diagnosed with type 2 diabetes, recommend the patient to get checked on their teeth
    • Effect of Periodontitis and Treatment
      • Painful, causing sensitivity, pain, and in some cases, severe pain
      • Untreated may lead to tooth loss (extraction) which has broader consequences (poor mastication, speech, dysphagia, ongoing problems with nutrition)
      • The proportion of adults with moderate or severe periodontitis increased with age, ranging from 12% in 15-34 year olds, 33% in 35-54 year olds, 51% in 55-74 year olds and 69% in those aged 75 years and over in 2017-18 (AIHW 03/2021)
      • Bidirectional relationship with type 2 diabetes - the presence of one makes the other worse
      • Treatment: 'Deep cleaning' is performed to remove plaque and calculus from beneath the gums; patients will present in pain and sometimes with mobile "wobbly" teeth; supply analgesics as well as chlorhexidine mouthwash TDS for 2 weeks + referral to dentist

    Gingivitis

    • Inflammation of the gums can be generalized or localized
    • Precursor to periodontitis
    • Can be treated with improved oral hygiene and professional dental prophylaxis (scale and clean)
    • Advise patients to brush twice daily as well as chlorhexidine mouthwash (e.g., Savacol) for 2 weeks

    Alveolar Osteitis (Dry Socket)

    • What: Localized painful inflammation of the bone surrounding the extraction socket following premature loss/breakdown of the blood clot
    • When: Complicates approximately 5% of extractions
    • Why: Pathogenesis is poorly understood; mostly secondary to smoking, excessive spitting; patients who have T2D, take the OCP, are female, and older age are likely to experience this
    • Treatment: Self-limiting, analgesics, and saline/chlorhexidine irrigation; supply analgesics to temporize until patient sees a dentist (Paracetamol (4g max) and Ibuprofen (2.4g max), generally 1TDS of each)

    MRONJ - Medication-Related Osteonecrosis of the Jaw

    • What: Exposed bone in the maxilla or mandible that has been present for more than 8 weeks following tooth extraction
    • When: In patients who are taking bisphosphonates, anti-resorptive or anti-angiogenic medication
    • Incidence: 1% in cancer patients and 0.1% in patients with metabolic bone disease
    • Why: Inhibition of osteoclastic bone resorption and remodeling; existing inflammation and infection from teeth that were removed; inhibition of angiogenesis (formation of new blood vessels)
    • Treatment: Counsel patients prior to starting anti-resorptive and anti-angiogenic medication, and advise them to see their dentist; ensure to advise that ulcers should not last for longer than 2 weeks (epithelial turnover time)

    Infective Ulcers

    • Ulcers secondary to bacterial, viral, or fungal infection
    • Examples secondary to viral infection: Herpangina, Hand, Foot and Mouth Disease (HFMD)
    • Treatment: Managing pyrexia, symptomatic relief for ulcers (also mention a bland diet - cold milk, ice cream, avoid spicy foods)

    Cold Sores (Herpes Simplex Labialis)

    • What: Recurrent oral mucocutaneous herpes simplex virus (HSV) infection follows latent activation of the virus
    • Where: Lesions usually occur on the lips but can also occur on the intraoral mucosa or other areas of the skin
    • When: Lesions usually preceded by the prodromal stage, lasting several hours to days, which features pain, burning, tingling, or itching
    • Recurrences are usually mild and infrequent; frequency can be minimized with sun protection

    Fungal Infections

    • What: Candida species are commensal organisms of the oral cavity; oral candidiasis is an opportunistic infection that is uncommon in healthy individuals
    • Why: Hygiene is important
    • Referral is necessary (either dentist or GP); intra-oral white lesions may be much more sinister and require further investigation

    Dry Mouth

    • What: May be the subjective sensation (xerostomia) or there may be a pathological problem (salivary hypofunction)
    • Why: Dehydration, alcohol, anxiety, mouth breathing, drugs (generally the "anti" drugs - anticholinergics, antihistamines, antihypertensives, antidepressants, antipsychotics, as well as opioids, inhaled bronchodilators)
    • Chronic dry mouth may contribute to tooth decay, periodontal disease, oral candidiasis, difficulty retaining dentures, difficulty chewing, swallowing, speech, and altered sense of taste
    • Relevance: Counsel about the possibility of this happening where relevant, any alternative medications; ensure adequate hydration, drinking water regularly; products that stimulate saliva, such as lozenges, chewing gum; artificial salivary products, e.g., Biotene; referral to determine cause!

    Edentulous Patients - Paediatrics and Geriatrics

    • Teething: Tooth eruption generally accompanied by pain, swelling, drooling, irritability
    • Treatment: Teething gels should not be used because of the lack of evidence of efficacy and the potential for harm; cold cucumbers; teething rings; rubbing the gums with a clean finger

    Denture Concerns

    • Loose dentures
    • Irritating dentures (sharp, large, uncomfortable)
    • Potential causes: May have been made incorrectly, old, broken, underlying pathology causing mucosal changes
    • Dirty dentures
    • Relevance: Can offer polydent (or other) products - self-use adhesive products as well as denture cleaners

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